Notification of Changes for Business Entity
General Information
Business Entity Name:	FIRST MERIDIAN TITLE AGENCY
Incorporation / Formation Date:
FEIN:	822419717
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	LAKE
Business Address
Address 1:	4420 SHERWIN ROAD
Address 2:	THE FRANKLIN BUILDING. SUITE 201
City:	WILLOUGHBY
State:	OH
Zip:	44094
Phone:	440-382-5515
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	8076 RAINBOW DRIVE
Address 2:
City:	CONCORD TWP
State:	OH
Zip:	44077
Indicate the type of change you are seeking
Address Change:	YES
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	NO	New DBA/Trade Name:
Amend DBA/Trade Name:	NO	Old DBA/Trade Name:
Add/Delete Producers, Members, Owners, Partners, Officers and/or Directors:	YES

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
MATTHEW J. BERNKOPF	LICENSED AGENT	1175089	YES		12/14/2017

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
ANTHONY TAGLIARINA	OWNER		YES		12/14/2017

Title Business Entities Only
1. Is any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance? (i.e. banking, auto dealer, mortgage company)	NO
2. Has any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance since the filing of the previous CN-65 or the original application?	NO
3. If the answer to questions #1 or #2 is yes, identify the business or profession and the nature of person's involvement

Submitted By
Submitted By:	RUSSELL ABRAMS
Title:	OWNER
Phone Number:	440-382-5515
Email Address:	RUSS@FM-TITLE.COM